Welcome And Guest Introduction

Dr Andrew Greenland 0:00

So, welcome to another episode of Voices in Health and Women, the podcast where we explore the people, the ideas, and the innovations shaping the future of healthcare. Today I'm joined by JD Enright, CEO and co-founder of Clear Commodio, a company challenging the traditional reactive model of cardiology to advanced imaging, artificial intelligence, and a strong focus on prevention. So, in this conversation, we're going to explore the business of building a preventative healthcare company, the challenges of changing established clinical thinking, the role of AMA in commodity healthcare, and the lessons JD has learnt from growing a specialist healthcare business. So, first of all, JD, welcome to the show. Thank you so much for joining us today.

SPEAKER_01 0:37

Thank you, Dr. Greenland.

Dr Andrew Greenland 0:38

I appreciate it. I'm glad to be here.

JD’s Route Into Healthcare

Dr Andrew Greenland 0:41

So, for those that don't know you, would you mind just sort of giving us a little bit of background about yourself and kind of tell us how you ended up in healthcare?

SPEAKER_01 0:48

Sure. It wasn't a direct line, that's for sure. And I probably speak for a lot of people who end up here. And you know, during that time, I saw a lot of care that went into the guys and girls at the academy when you're out on ships. And I said to myself, you know, there's a big opportunity here for health care specifically around that space, right? So then I went to work for US government. I worked for the US government for about 10 years. And mostly that time was overseas. Um, and during that time overseas, um, I noted that the healthcare situation, at least in the uh areas in the regions that I was located, um, was seriously lacking. Um and compared to the US, you know, I didn't really appreciate what we had in the US. Um, and um after I left um Uncle Sam working for the government, um, I got into I went back to school, um, went to uh Cornell and um got a degree in in um in business, um, and then on to Wharton for finance. Um and during that time I was working for various companies, one of which uh was a pharmaceutical company called Astra. Um before it was AstraZeneca, now it's AstraZeneca, um, and that was in Massachusetts. And that's was, and I was in an engineering role, uh project management engineering role. Um, and that's what gave me my real first exposure to healthcare on the, I'd say on the drug manufacturing development side, um, to really see what goes into you know early stage, mid-stage, and even late stage drug development, um, which in many cases, if we're talking about and you know, clericardio is specifically um on the cardiovascular side, but you see that like statins and medications and things, and the significant amount of effort that goes into money, time, resources that goes into developing these new generation drugs. Um, so so that was really my real first step into healthcare was really on the on the drug manufacturing side with companies like uh Genentech and um Wanza out of Switzerland and so on. Um, and that gave me a good sense and appreciation for the tremendous amount of effort that goes into developing these medications. Um, and so uh during that period of time, um I worked my way up the ladder. So I started off as a project engineer um looking at uh developing um processes to allow those drugs to be manufactured from early stage clinical trials, you know, even toxel levels. So you use a small bench top type manufacturing, um, all the way up to you know, with with uh Genentech 30,000 liter stir tank reactors, um, making a perceptin and things like that, right? So for cancer treatments. And so I started off doing the designing engineering stuff and then slowly worked into the business side of things. Um, and then ultimately my last job in that space was I was head of global strategic growth investments. So I was uh out there acquiring companies on behalf of Lonza. So I was based out of Switzerland for a number of years, um, in VISHP and in Basel, which is where their headquarters is located. Um, and I was uh responsible for identifying novel companies that were emerging out, had great technology, good IP, um, and specifically in the viruselling gene therapy space, um, including things like CRISPR and and and you know, transfection, gene editing, things like that. Um, and um ultimately acquired a number of companies in that role, brought me to Texas because we acquired a very large company um and built out the world's largest uh viral cell and gene therapy uh manufacturing facility at the time. Um and um and that's what brought me to Texas. And um it was during that time, right after I left Lanza and started my own company um called TMG Core, Texas Machine Group Core. Um, and that was based in Dallas, Texas. Um and the reason why I stepped out of Lanza and into that, you know, going to start my own company kind of thing, um, was I saw the importance of technology in the development of these novel medications. One of the drugs that we worked on um at Lonza, which really took root in my soul, how important that is, um, was a drug. We we worked with a company called uh Bluebird Bioscience out of Cambridge, Massachusetts. And with our help, they received FDA approval for the world's first curative medicine for adrenal liquid dystrophy. Adrenalucystrophy is a relatively rare disease, but it still affects roughly 15 to 20,000 young girls and boys, mainly boys, um, and it's and it's basically a death sentence. Um, it's demyelinization effectively and in the brain, and um it it causes death. And so that us building that facility, uh investing in that technology uh to be able to produce that drug product safely, effectively, um, at a cost that was reasonable, right? And in a time frame that, you know, we you know that would facilitate preventing from you know all of these children from dying effectively from the disease, um, required a bunch of technology. And I saw how important that was, and and it was through technology uh and applying that technology, the development of and the implementation of that technology that I saw um save lives. Like truly, I could see I met the patients, the children, their parents, they would come into the facility um and tell us their stories. And so it was really that that embedded itself and I saw how important it was. So I left Lanza after I had built that out. I felt I had accomplished that, and I decided to start a company that focused it focused just on the technology side. Had very little to do with healthcare at all, other than to say the it was high performance computing, next generation immersion cooling in dielectric fluids. So we could get extremely powerful computing because most technology requires, especially nowadays, real high performance computing um capabilities. And the limitation is something called Moore's Law. Moore's Law is like it's you know, as your as your computing power uh expands or increases, the amount of heat load through the electrical demand increases. And at some point, you just can't cool it. You can get smaller chips that have more power capability, but they also demand, they also irradiate more heat, and you've got to dissipate that heat, or they fail. And so we were able to overcome or extend Moore's Law by developing something called two-phase and single-phase immersion cooling, where we would take the the chips um and the boards, and we developed the most advanced computing in the world at the time, um, and immerse them in these fluids and cool them and get a lot more uh computing out of them in a much smaller space, something the size of uh of a um you know, of a cabinet, you know, like a you'd have in your office, could be a hundred kilowatts, which was unheard of. Um, and it was portable um and self-sustainable. So that was you know really my step into technology during that period of time. Um, and feel free to interrupt at any moment. If you have any questions, please just jump in and I can elaborate on any of that. Um, but uh I've been known to be a little long-winded, but I'm very passionate about uh about what I've done in the past you know and what people I'm working with are doing.

Key Man Insurance Checkups

SPEAKER_01 9:44

Um so it was during that time um as the CEO of the company um that my shareholders required me to have um something called key man insurance. Um for those of you who don't know, key man insurance is when you're an executive in a company, whether it's publicly traded or privately held, um oftentimes um the shareholders um board of directors will require the CEO or other members who are critical, chief scientists, things like that, to have something called key man insurance. So they'll open up a life insurance policy on the on that executive or that individual. And uh in case something happens to them, um they can then the company isn't in such a financial or um leadership um I guess position where where you couldn't replace that person. And so they could go out and hire a new CEO, bring in a new, you know, and that's expensive, that's an expensive process. So so um the insurance company required me to to um to go to um a clinic um every quarter, so four times a year. Um, it was one of the number one clinics in the country that I would go to, private clinic. Um, very expensive, cost about $15,000 every time I went. I'd get there at six in the morning, I would leave at six at night, I'd wear my tracksuit, um, and they'd run me through the gamut. It was like, you know, the American Ninja with that show where you're just like from one to the next, like literally room to room to room to room. Uh I'd have like a little snack in between after I'd bet faster for the blood work, but I'd go through this whole regiment of everything you can imagine. And I'd walk out at the end of the day with a big binder um and a consultation with the doctor because they do everything real time. So I get all the results the same day, which I thought was remarkable. I'm like, this is the greatest thing since sliced bread. I mean, like everybody should be able to do this. Um, what I didn't know is that that big binder that they gave me was in it at the time for me, was like, you know, hieroglyphics. And you know, I would say, How am I? And they'd say, Well, your cholesterol is a little high, but you have a zero calcium score. Uh, you ran on the treadmill for 20 minutes. That was pretty impressive. Um, we didn't see any problems with your ECG. Um, you don't have any skin cancers, and the list goes on. And I'd say, Well, do is there anything I need to do? Like, well, you're you know, you're in your late 40s, early 50s at the time. Um, you know, just watch what you eat and uh, you know, that kind of thing. And then they would stamp approved, and the insurance life insurance would company would get the then everything was good, and I'm covered. It was a hundred and fifty million dollar life insurance policy. Right, so pretty substantial. Um, and I did that for five years, four times a year, uh five time times five years. So think about the cost associated with that. But they kept telling me, yeah, everything okay, cholesterol is a little higher this time, or you know, but I was I was not I was asymptomatic, I had no symptoms, I wasn't feeling bad or anything. But I was in the middle of taking the company public at the time. This was in 2022, and um the market crashed at the time. I mean, when you're taking a company public, um, you know, that's there's a lot going on there. There's a lot of stress and pressure in my cortisol levels, I'm sure, went through the roof. You know, uh, I'm working 18 hours a day, working seven days a week. In fact, for the first two years of me building that company, um, I lived in my office. I physically lived in my office. I had a bunk bed in my over my desk, um, and I put a shower in. I was at an 11-acre campus that we built out, 150,000 square foot facility. So I had a substantial size office, but still, I lived in my office. I drove home on the weekends when I could to see my children and my wife of 30 years. Um, but that's what I did. I was that dedicated, as did my chief techno technology officer. He lived in there right in the office right next to me. Um, so we became very good friends over the years, as you can imagine. Um, but so during that period of time, you know, I I was I, you know, especially in 2022, we were getting ready to announce, you know, our you know, we're going public. We were unwritten by Guggenheim and Credit Suisse and and all of that. So we were it was a big deal. It was going to be a very big IPO on a stacks. And then the market crashed, if you remember. The world ended in June, um, like about a week before we were scheduled to announce, and all of a sudden, you know, Silicon Valley Bank went out of business. Uh, credit suites got broken up into little bits and pieces. Um, everybody kind of just the whole world sucked. Um, and so we collectively decided that we're not going to do this today. We're gonna step, you know, hold back on the IPO. However, that kicked off a series of of events where I decided collectively with the board we were going to go to private say. We had shareholders who wanted to exit. Uh, they had been in the business for a while, they're a little older, um, looking for some liquidity. So we decided to go down and exit and we started negotiating with a company. Now everybody knows it's public. It was Modine. It was a very big deal at the time, probably one of the largest private deals out there. Um, so I was living in aircraft, hotels, boardrooms, surrounded by lawyers, eating way too much, you know, restaurant food, certainly drinking way too much wine and whiskey, uh, and probably too many cigars. Um, but that's what you do, like when you're in the middle of a deal. It took us nine months. During that period of time, I gained 15 pounds. I started, I grew a beard so that no one would see the fat under my neck. Um, I wasn't feeling too hot because I wasn't sleeping very well, because I was having dinners with lawyers and and you know, negotiating deals and so drinking a little too late and not getting enough sleep. And it just kind of accumulated, it did accumulate over time. And

IPO Stress And Health Decline

SPEAKER_01 15:54

and so I went to my next door neighbors. I'm about eight months, nine months into this into this transaction, very large transaction. Um, and my next door neighbor is an interventional cardiologist. Um, his name is, and this is coming full circle here, his name uh is uh Dr. Rajul Kazori. Um, and he's the guy that nobody wants to see, right? He's the one that you're having, you're very symptomatic. Um, you or you had a heart attack or stroke, or you're in the middle of having a target take or stroke, even worse, and he's the catheter guy. He's gonna go in there, he's gonna put the stints and the balloons and stuff like that. Um, and his colleagues do the bypass surgeries, the revascularization, and things like that. Um, but I went over to his house uh with a bottle of wine in my hand, um, and he goes, JD, you look like hell. Like what happened to you? I haven't seen you in a while. He goes, You don't look good. And and and when a when a when an interventional cardiologist tells you you don't look good, you need to do something about that, right? So he said, I want to introduce you to a gentleman. His name is Dr. John Osborne. And Dr. John Osborne um took me the next day. I literally went in the next day, literally in the back door of the hospital where he was, you know, doing his thing. Um, and within an hour, okay, now think about the context here. Five years, fifteen thousand dollars a shot times four times five, right? You're talking about a half a million dollars, five years going to the what's considered the number one clinic in Texas for sure, one of the top in the country, um, private. Uh and he tells me in one hour what they couldn't tell me in five years, and that is I had stage two um disease. And by stage two, a lot of people don't know that we can actually stage disease now, uh cardiovascular disease, like oncology has been doing for years, staging cancers,

One Hour Diagnosis Shock

SPEAKER_01 17:50

um, level of disease. Uh, so stage two, I had 260 millimeters of soft plaque. A reason why I had a zero calcium score because none of my plaque was calcified. So we know that calcium scores really don't mean anything other than if it's positive that you have the disease, it doesn't mean how much you do and where it is and how active it is and how much plaque you have. We all we know all this now. I certainly know it all now. But I had 200 and plus millimeters of saw plaque in my LAD, um, which you know, we a lot of people call it the widowmaker, um, all right there. So I was at a substantial risk of a heart attack and stroke due to plaque rupture. Um, a lot of people don't realize that plaque rupture is you know what causes most heart attacks is strokes. It's not uh and I put a whole video out about what that is. So in one hour, he told me what they couldn't tell me in five years, uh, half a million dollars later, and and that made me really upset. Um, I got upset for a number of reasons. Um, I got upset because I spent, or the company had spent half a million dollars going to this clinic. I had spent five years going every quarter running on treadmills with masks on and ECG leads and having fingers up my butt and you know, all of that stuff that they do, right? Um, and me thinking that I'm great, okay, it's worth the money. Um, only to find out in one hour that they did nothing for me. Zero. Right? Uh they tried to put me on a statin at one point, and I said, Well, how do you know if it's working? Well, your cholesterol came down. Well, what does that mean? Like, is my is that cholesterol bad? Like, like, help me understand that. And it just went around in circles. So I got upset at that. I got upset that I was at risk. I've worked my whole life really hard educating myself, building businesses, um, creating wealth for other people, myself included. Um, I have two children, um, son and daughter, uh, and an adopted daughter as well. Um, and you know, only to find out that I was at a risk of a heart attack and stroke and dropped dead, because we know now, statistically, you know, half the population over the age of 40 or 45 uh will have some type of event, heart attack or stroke, and half of them will their first symptom is death. Right. So that's scary. And then I got into the point where I was upset that why isn't everybody doing this? Why isn't this the state? Why isn't this the you know standard of care? It's been around for a long time, like you know, CTs, CCTAs, things like that now have been around for a long time, imaging. Now, the the FDA approved AI tools that we use have not. That's relatively new, so I understand that. Um, but it's a game changer, it's an absolute game changer. So I said to myself, you know, I'm gonna get through the sale of this business, TMG Corp, and then I'm going to do something about it. I'm gonna put my time, my wealth, my my business acumen, and I'm not a physician, I'm not a doctor. Um, I'm just a I'm I'm I'm a patient of clear cardio. I am I am a I'm a businessman, so I know how to build businesses and make profitable businesses. So I'm gonna take that acumen and I'm gonna put it together towards towards this particular issue, and that's cardiovascular disease, which causes you know heart attacks and strokes. Um and that was the genesis, that was the you know, the ideation of clear cardio was uh so I got through the sale of the company and then met with Dr. Osborne. Dr. Osborne was had a small Regis office, um about the size of my wife's shoe closet. Um because he's such a kind man, he's such a philanthropist, he wants to save the whole world. I mean, he's a Harvard trained guy. I mean, he's I mean he should you should have him on at some point, but he's a remarkable man. And but he's he's Just not good at business, he admits that, and so he's been trafficked his whole life. Um, and I call it that. I mean, I really just put that tag on there. He's been trafficked, you know. And and so, you know, he had a small little registration office with all he has so many degrees and licenses, it took up every inch of the walls in his little tiny office. And I said, We gotta get you out of here. We've got to wrap a business around what you've been doing and telling people we should be doing for the last 20 something years. Um, you know, and because he stopped doing heart catheterizations 20 years ago, um, and only uses imaging now. And now with the AI tools, it's even better. He's developed this incredible program, uh, which I follow. Uh, right now, by the way, uh, I have no more soft plaque. I went from no calcified, no calcium, no calcified plaque, so zero calcium score, which for all indications would tell me I'm in perfect shape um because I looked good. Uh, but to see having 260 millimeters of soft plaque, now I've got um all of that is calcified. So I have effectively a zero risk of of plaque rupture. Um so no more heart deck or stroke risk. So I'll probably die of cancer. Let's let's hope not. But that's statistically speaking, that's that's the case. Um, but knock on wood. But um, so so we know I know the program works because I'm living proof. Um, and so we did we we adopted that program that he's developed um using some medications if it's necessary, uh, have significant disease, and that's what we do. Um, and also diet, exercise, all of the things you know you and I chatted about before we started this podcast was you know, roughly, you know, about the functional side of things and the importance of that, you know, getting your visceral fat down, all that. So that was the genesis of uh of pericardio, and that was um almost three years ago. Um, now we started uh I see TMG Core sold in December 2023. So we are now you know coming around to almost four years, I guess. Um but um that was the ideation.

What Cardiology Gets Wrong

Dr Andrew Greenland 24:12

Fantastic. Thank you. Thank you for sharing that backstory. It really provides context for everything that you're doing and your sort of personal experience of how you've ended up in this situation and the direction you've taken with the business. So I suppose your experience is quite unique in the sense of probably nobody else is going to have the level of health screening that you had, you know, with that company that were paying all this money every year. But what's fundamentally broken about traditional cardiovascular care that you know the average person experiences um in the US?

SPEAKER_01 24:40

Well, that's a great question. Um I can tell you, I I was fortunate because I could pay, I could afford, and the company was paying as well for the private care. Um, most people can't. And so what happens is they end up um what I call in the you know, kind of like the circle of death, right? So um health care in America is fundamentally broken. Um it is quite good once you get the care. The doctors and nurses and nurse practitioners and the folks that are giving the care are outstanding. Um, I think it's one of the best systems in the world, at least from a training perspective. However, to get to the those experts, that's where it's all broken and whether or not you can actually get them. Um, and so, you know, today, if if you're my age and you're not symptomatic, or let's just say, you know, I'm 58, okay. Um, let's just say you're in your 40s, late 30s, early 40s, and you're non-symptomatic, okay, because a lot of people in their late 30s and 40s and 50s die of heart attacks and strokes, men and women alike. Um, and why do they do? A lot of times because they're asymptomatic and they have a plaque rupture. They didn't know they had significant plaque. Um, they didn't know what plaque rupture was. Um, and I've actually got models and things like that that show how it works, and pretty interesting. I've got some videos out there to show how it works. So educating people. But a lot of people are not educated because there's not a lot of information out there about that. Um, so so you either have to be symptomatic, okay, which means you have late stage disease, you know, 70% blockage or more stenosis, you know, the narrowing down of the artery going from something like this, which is a normal artery and you know, wide open flow, no stenosis, no ischemia, things like that, to something that looks like this, right? Which is, you know, this is about 70 to 80 percent blocked, right? So reduction in flow. So this is significant stenosis outside in the wall of the artery here, that's where the uh plaque builds up. So plaque doesn't build up. A lot of people think plaque builds up on the inside and sticks to the wall of the artery here on that one cell membrane. There's a little membrane on the inside of your of your artery here, which kind of protects you know that. And it's when you're born, it's like a slip and slide, right? From the 80s, you know how it's like it's like Teflon. Everything that flows through the blood, everything that's in the blood, the oxygen and and and cholesterol and all of that stuff, it's just flowing through and nothing adheres to that line, that thin lining. As you age, um, you know, uh hardening of the arteries or lifestyle or genetics, genetics plays a big role. Or as you age, uh, you know, you gain visceral fat, fatty liver, uh diabetes, um, you know, all of the high

Plaque Rupture Explained

SPEAKER_01 27:35

blood pressure, you know, hardening of the arteries, things like that, that lining becomes damaged and it becomes more like velcro instead of Teflon. And what happens is that cholesterol in particular adheres to a certain area in the in the artery. And then what it does is it gets absorbed into the wall of the artery. It doesn't stay on the on the aligning here, it gets pulled into the artery wall, like that, right? So even if you put a camera like a heart catheterization down the center, you wouldn't see plaque. You're not going to see plaque and what kind of plaque it is. So heart catheterizations from understanding the level and and and the type of disease you have, um, is useless. It doesn't tell you what type of plaque you have, doesn't tell you where the plaque is, uh, and and how much of it is. And we know that you know the soft plaque. So if you see the color coding here, the blue is the calcified plaque, um, the yellow, and we color coded specifically so you can identify it here. Um, but the blue is calcified plaque. We don't care about that because it doesn't rupture, it's stable plaque, so that's old plaque that's turned hard. Um, and then the soft plaque, what we call the medium density, high lipid, think of lipids as fats, like butter, right? That's the yellow stuff. And then in here, the little red stuff, that's the low density, what we call the lava, uh, low density, high lipid plaque. So these two plaques, these yellows and reds, these are the real dangerous stuff. That's the stuff that ruptures through the lining. And it's when it ruptures, which causes you know 85 to 90 percent of all heart attacks, you know, uh, versus, you know, that's the plumbing issue versus the electrical issue, which is the, you know, if you've got AFib or something like that. But in this case, we're talking about plaque rupture, that ruptures into the blood flow, and then your body responds in minutes to seconds, causes the clot, and it's the clot that blocks off the blood flow, which stops oxygen to the brain or to the organs and the heart, and that's what kills you. So, this is what it normally looks like. This is this, and so you can see how it expands out. So this is your normal outside diameter. Then it as that as that cholesterol gets absorbed, looks as it gets absorbed into the arterial wall, it starts expanding outwards first, pushing that artery so it expands like this. And while it's through that, at the same time, it's pushing down on that, on on the uh on the uh interior on the lumen here, and it causes what we call stenosis, and that's you know, cause symptoms, you know, shortness of breath and high blood pressure and all those types of things, right? So normal, not normal. This is so so you know what we do is we we identify that right off the bat. Like, do you have it or not? So the problem is 90% of the cardiologists out there are not preventive cardiologists, probably more than that. Um, they're not trained to communicate that to patients. Um, their go-to is especially an interventional cardiologist, their go-to is stents and balloons. And in some cases, if it's if you're serious enough, revascularization, you know, effectively a um, you know, bypass surgery. And and there's a lot of money in that, right? Um, and but oftentimes you're not getting to see a doctor to even determine if you have the disease unless you're symptomatic, because you're depending on your insurance company to pay for everything, the doctor's visits and things like that, because they're not cheap. Um, and it can take a significant amount of time because doctors, right now, you you know, they're two, three months out. So you got chain pet uh pain in chest. Okay. Then you go to see your regular doctor or you go to the emergency room, and they they might brush you in to do an emergency heart catheterization, right? Which is invasive, can cause, can cause heart attacks or strokes, can cause infections, and you may not, it may not, it may and so, and then if they do put a stint or balloon in there, all they're doing is addressing the symptom, right? Because stints and balloons don't actually address the underlying disease, right? They don't stop heart attacks and strokes. It's that's not their job. Their job is to open up, you know, push against the arterial wall here and open up so that you can get more blood flow to so you're not symptomatic anymore, right? And so so you get uh so, but it's not addressing the disease which is out here in the arterial wall, which you can still rupture right through the around and uh stint. So it's just to resolve symptoms. So the biggest challenge I see right now, what's broken, is first of all, people getting having the education and doctors educating the patients, whether you're a generalist or a cardiologist, it's the the dependence on your uh healthcare insurance to allow you to have your insurance cover you to go see a cardiologist, right? And then what happens? Okay, so if you think about the circle of death that I talked about, you got to have a symptom, okay, or you're maybe you're doing, if you're lucky, a lot of guys and girls don't. There they go in and they get a checkup and they fail a checkup. Their ECG is weird. By the way, ECGs are for electrical issues, they have nothing to do with plaque. So uh that's useless when it comes to 90% of the hard tax and strokes. Um, so but it's you it's useful for other things. Um, they put you on a treadmill. You have to fail a stress test, right? Um, in order to actually go on to be referred to a cardiologist, an expert. Um, and we know that stress tests um have false positives and false negatives. So if you fail a regular stress test, then they put you and they do a nuclear stress test. Um, they'll look at your calcium score, which only shows you if you have old plaque, say if you you have active plaque. And then if you fail all those, then they'll say, okay, now the insurance company will pay for doing a heart catheter. By the way, a heart catheterization again only treats the symptoms, it doesn't treat the underlying disease. Um, and you can do everything that I just talked about by doing a CCTA, cardiac CT angiogram, which will show you definitively if you have the disease.

CCTA Imaging Plus AI Plaque Maps

SPEAKER_01 33:46

Then you layer on the AI on top of that, uh, which analyzes you know 20,000 pixels of you know of imaging on the CCTA. The CCTAs that we use today in the CT um machines, uh, we're using state of the art. So it's 620 slices for those of you who don't know what that is. Uh a 620 slice machine um is the most advanced in the world, it's AI enhanced, and it's the amount of uh of pictures it takes um of your heart and your system. We can do it from your carotid all the way to your belly button, and we can see with extraordinary detail um what's going on. We create a three-dimensional model um of almost a perfect uh three-dimensional model of your exact physiology, your heart, your kidneys, your livers, your everything, bones, structures, flesh. Um, and then we can actually fly down your arteries and all of that. We can do all of that, and then we layer on the AI tools, the plaque analysis tools, which then takes a look at that that plaque um and categorizes a plaque, quantifies it. So, what kind of plaque it is, how much it is, and where it is, and then we we tell you what level of disease you have, and then we know how to treat you exactly, how to convert that soft plaque into hard plaque. So we know all of that now. So that circle, so most people never get there. Most people, half of all people who have a heart attack or stroke, roughly half die, their first symptom. Um, the other half survive. The ones who survive after they have a stroke, significant can be significant brain damage, um, you know, a lot of recovery, a lot of costs associated with that. The others are now getting stints and balloons, or worst case scenario, they're revasculalization or or they're having um bypass, you know, bypass surgeries. But that's too late. Like that's way too late. We know now if you're pre, if you're if you're proactive, then you can help prevent some of those heart attacks and strokes, a significant portion of them, and actually start reversing the disease, slowing down the plaque, soft plaque formation, slowing down the the um, and and speeding up the calcification process, which is stable plaque, calcified plaque, uh, and then and then ideally eliminating uh or or significantly reducing the amount of new plaque formation that's created. And that's the goal.

Dr Andrew Greenland 36:21

So why is prevention such a difficult conversation? I know you kind of earlier alluded to the fact that you know you have to have a symptom to get seen by the right people. But in terms of patients, how do you persuade someone who feels well that they need investigating?

SPEAKER_01 36:34

It's not easy. Um, it's and it's and all a lot of it just believe it or not, unfortunately, it's even today because it isn't widely known, um, you know, and insurance for the most part won't cover prevention,

Why Prevention Is Not Covered

SPEAKER_01 36:48

um, which is a major problem in this country. Again, circle of death, right? Um, they just don't they don't value it. I think that is going to change. That is going to change. It is my life's mission, it is Dr. Osborne's mission, it is all the staff here at Clear Cardio and others out there. There's others out there, uh preventive cardiologists who are out there and care about this. But um, you know, they just won't cover preventive. And so the conversation we're having with patients is because we don't take insurance. We can't. There is no insurance to take because they'll they reject it every time. We tried in the beginning, and it was just futile. So the conversation is um um, okay, you're over you're over 45, you're 50. Most of our patients are over 40. Um, not all of them, but most of them. Um, and for some reason that's when the light goes off and you're like, oh, wait, you know, I need to do something. Um, or they've had or they're having symptoms, but non-symptomatic people, um, once they find us, they're usually the people that are worried well, the ones that are doing the research are out there looking on the internet, um, but they're still asking the questions. Uh, or if I'm having a conversation at dinner uh or in an elevator, someone will say, What do you do? Oh, I've been cocaine. What is that? Oh, why do I care? But what's plaque? Is that in your teeth? I mean, like, no, it's not plaque in your teeth, it's the number one cause of heart attacks and strokes. Um, so I always say this have you had a colonoscopy? Most of them over the age of 50 in their 40s and 50s will say yes. I'm like, okay, why did you do that? Well, because they told me I should. Why? Well, because I don't want to get colon cancer, right? Polyps, like a lot of people are very educated about colon cancer. I said, okay, that's great. I said it's important to continue to do that. Um, however, you know, cancer in general, um, compared to heart disease, heart attacks and strokes, uh, makes up a much smaller segment of mortality. Uh, and in fact, roughly 2% of cancers uh are associated with colon cancer. Um and and and even fewer, you know, go on to pass away as a result. However, it doesn't mean you don't do it, right? Just because statistically it's lower, because nobody wants colon cancer. But you do it anyways. Okay, great. Now take that and apply that to the number one cause of death on the planet. The number one cause, heart attacks and strokes. And most of them, 85 to 90 percent, are due to plaque rupture. Don't you think it makes sense that we would have a preventive program to go in there to determine whether or not you have the disease? And if so, what to what level? And unlike uh unlike colonoscopies, where you can go in and remove the polyp and voila, no more cancer or no more potential cancer, right? Um, and so come back in three years. You can't do that with cardiovascular disease. Um, what you can do, however, it takes longer, is treat it, slow it down significantly, or even stop it and allow that soft plaque, the dangerous plaque that can rupture, to stabilize and convert to calcifide plaque. That takes time, effort, and you have to understand the type of plaque you have, where it is. And then your physiology is uniquely yours, and therefore you may have a disposition, genetic disposition in your family, right? So we take family in account, you we do blood tests um to determine whether or not you have a genetic disposition for you know um converting um cholesterol into plaque, you know, through the arterial wall and all of that. So we look at all that, right? So wouldn't you say that's even equally as important, or maybe even more important, statistically speaking? And the answer is always yes. Absolutely. I didn't know any of that. They're like, of course it is, yes, okay, great. Do you take insurance? Nope. Uh, we don't take it. We unfortunately your insurance company won't cover it unless you have your symptomatic. And we can't tell you to say that you're symptomatic, right? And so, and most people aren't. And so, you know, they either have to lie to their general practitioner and say, I have heart pain or I have something, right? Um, in order to go see a cardiologist, but then they're gonna they're gonna end up with a cardiologist who's ideally, or not ideally, who is most likely a cardiologist who is not doing the advanced systems that we're doing, doesn't understand yet what's available to them. And their first diagnosis is let's get you on a treadmill, let's do a stress test, let's do your calcium score, CAC score, let's, and then let's get you in to do a heart catheterization. Right? That's their path. That's the path they've been following forever. So the conversation to your question is it's a challenging one. It's one of education. Um, and it's just telling them what's available to them. And then, if assuming they can get out of their mindset that the insurance companies have their best interests at heart and that they're going to cover them, and then they have to come out of pocket for it, right? We've worked really hard to get the prices and pricing down as low as we can get it and still be in business because we can't run a business. And this will go towards the part of this podcast where we talk about how important the business is in order to sustain the technology to be able to get this to the masses. Um, but uh, you know, they they have to prioritize where they spend their money. I mean, people walk around with a $2,000 phone, okay? Our program isn't much more than that, maybe a little bit more, right? Yeah. But it's a phone, right? The phone's important, but phone's not going to save your life.

unknown 42:41

Okay.

Selling Prevention To Well People

Dr Andrew Greenland 42:42

So I guess you what you do at Claire Cardio, you're you're challenging healthcare, you're challenging the status quo, you're asking healthcare to think differently. What sort of resistance have you had? And how do you respond when people challenge what you do?

SPEAKER_01 42:54

That's a great question. You got some great questions. Um you know, a lot of times we'll we'll put in the effort. Um we don't get a lot of challenging from from potential patients or patients. Once patients see it, you know, I'm a believer that when you hear the truth, you know the truth. Like when you hear it, you go, uh, yep, that that makes, yep, that's true. Um, and you can't argue with facts and truth. And and that's what we do. We we bombard people with facts and truth. We prove we we prove it to you, right? We're not just, you know, it's not just, hey, let's take some medications and trust me. Uh, we can show you, because we can we can do these things, you know, again. And then we show you the images here's where your plaque was, here's where it is today, you know, da da da. And we monitor you as we go forward. So it's a proof program, um, proving that that we're we're treating the disease. Um but when we're talking to insurance companies uh uh on a day to day basis, um Um which isn't something that most of my team does because again we don't interfa interface with the insurance companies. Um but when I'm having conversations at uh events or um you know, when I'm doing a podcast, things like that, the it's all about again, just talking about the facts and and and the underlying uh like how does this benefit you? You know, my father used to tell me you'll never be successful in business unless the ecosystem that is that you require to be to have that business be successful, your suppliers, your things like that, unless they see a vested interest and they in in in what you're doing. And so, you know, there's we take that approach. I take that approach. I say, okay, how do they how can they benefit from what we're doing? Um, lowering healthcare costs, right? Um in the case of life insurance, for example, that's an insurance, right? It's not medical insurance, but it's life insurance. They are starting to wake up. We're doing, we're having a lot of dialogues with some of the biggest life insurance companies out there. And we're able to extend the life in many cases, or at least we're working towards extending the life of their policy holders. Um, and we can also provide them with um with information um that helps them make better decisions on underwriting. Um, so they see the value there. And and most of these life insurance companies have a division that does healthcare as well. Uh, and so we're we're we're hoping and praying, I hate that soft language, but that that somehow translates over across the aisle in the offices, in the buildings that they have and saying, hey, no, there's real value in what they're doing. Let's start covering some of this stuff. Because the minute they start covering some of this pre preventive um medicine, what we do, then we will start taking insurance 100%. Um, they're just not there yet. But um, but as far as talking to patients, they when they hear it, they go, Oh, I get it. It's just an education process. But when it comes to now, private equity firms, completely different issue. Private equity firms or investors um in companies that do interventional cardiology do not like us at all because that is their bread and butter. They get $20,000 to $30,000 per heart calf. They get, you know, three to four hundred thousand dollars for revascularization for open heart surgeries, stints and balloons, add, you know, onto a if you do a heart cath and you add a couple of stints, you know, now you're talking about close to 70 to 80,000, $90,000, right? And then they're doing, you know, one heart cath doctor, one interventional cardiologist, is required if they're under the private equity you know umbrella of companies, a group, as it were, or even a hospital group, um, they're required to do you know as many as they can do a day. So they're referring people to the cath lab. Well, you got a little thing. Oh, it's I

Resistance From Incentives And Investors

SPEAKER_01 47:08

might as well just do a heart cat. Might as well just do a heart cat. And then if they see a 70% blockage, which they could be asymptomatic, they could have no problems, no, it could be all calcified, there's no risk of rupture, but they'll put a heart cat, um, they'll put a stint or balloon in there, and then they're on blood thinners for a year and they're higher risk of bleeding, it can cause a heart infections, things like that. But they're doing it because it's a business. Unfortunately, it's a business for them. Um, and so they don't like us. So we're not having much conversation with those folks.

Dr Andrew Greenland 47:44

Got it. Um, so turning now to more the sort of business side of the operation at CleoCardio, and one thing I really admire is it's um Cleo Cardio has really stayed incredibly focused. You know, rather than trying to become everything to everyone, you've built the business around solving one problem exceptionally well. What's your kind of philosophy behind that and in terms of you know that decision and also how it's affected your growth?

SPEAKER_01 48:05

Yeah, yeah. So, again, another good question. Um, and a fundamental question, um, and it's something that I've I've learned over the years um by making mistakes, is that you've got to specialize, you've got to be focused. So, you know, when I first effectively stumbled onto Dr. Osborne, and then I realized that you know, there was a huge opportunity to save a lot of lives, myself included. Um I said, okay, look, what are we what are we going to do here? Like, do we want to be everything for everybody? Like, like, because Dr. Osborne has, he's an internist, he's a lipidologist, he's a PhD, he's a this, like he's all of those things. You know, do we want to? I want to do this to help save lives. Do we want to do you know, other things, pain management? Do we want to do well? And the answer was absolutely not. Because I learned over the years that you know, find one thing that you're really good at and own it and be the best in the market at that. Let everybody else who let them weren't worried about that other stuff. Um, so I said, you know, what is this issue? It's plaque. Okay, what causes most heart attack? Plaque. So we don't we don't treat people per se, we we refer them out if they have AFib and they need pacemakers and they need all of those types of things. That's not what we do. That's a smaller percentage, or if five to ten percent. And so we to people, there's experts out there, that's what they do. But I recognize that because now we can narrow down um our ecosystem, it makes it simpler. Our suppliers, our partners, the people that we depend on and will depend on us um to be successful. Um, and and we can we can negotiate better because that's what we do, um, and get the pricing down so we can make it more available to more people. Um so specialization is critical. I think you see that in law in a lot of you know, in a lot of um um industries or or um you know things that people do to make money these days, right? So doctors specialize. Um, and a business should be no different. Um, because the minute you start to try to be everything for everybody, you do nothing really well. Um, and so we want to do this, we want to be the best in the world at it and give the best care.

Dr Andrew Greenland 50:29

So we'll also talk about um education and marketing because that's a key part of what you do. And I think your colleague mentioned that around 95% of your patients come through YouTube, which is quite remarkable. Um, so how did that happen? And what's your kind of take on education in terms of advancing

Staying Focused On One Problem

Dr Andrew Greenland 50:44

the business?

SPEAKER_01 50:45

Well, I didn't know it was 95%. So you're talking you're referring to Sherry Thacker, who is she's remarkable. She's she is such a rock star, she's such a powerful lady, um, and she's so engaged in clear cardio. It's like her, she's made this her life mission, and she's been a health advocate her whole life, written books. Um, but I didn't realize it was 95%. I I knew it was, I know we did we have an affiliate program, which is really exciting, where anybody, and we a lot of our patients have become affiliates um who make referrals and then we give them discounts, or you know, we we we give them um incentives to bring patients because we want to save lives. Um we we do get some doctor referrals as well. Um we're a member of the private physician alliance. Um so you know, I think we're the only preventive cardiology program within that national program, which is scary that we're the only ones doing this. Um, but uh, but yes, you two. One of the things that I I right from the onset, um, especially when I engaged, one of the reasons why I engaged with Sherry three years ago now, um, because she's really good at that stuff. That she likes that's her mainstay. Um, and so I knew right up front that our strategy was direct to consumer. I knew what that meant because I've done this before, um, which means we have to be really, really good at social media. We have to be really good. Um, in fact, I invested in built out and hired staff. We have our own podcast studio um in our headquarters, which is in Carrollton, Texas. Um, and it's right next to the VIP lounge where we bring our patients. Um, and um, so we do podcasts all the time. We do patients. So I knew it was important to get on all social media outlets, um, Instagram, things like that, and then put a message out there because I also knew that going direct to consumer in this case, because we don't have a lot of doctors who know what we're doing, understand what we're doing, or care what we're doing, because they're not educated on it. And they're they're so busy and so overworked, and they're especially in the cardiovascular space, they're doing balloon stints, bypass surgeries, all of those things, you know, running on treadmills, all that stuff, that they don't have time necessarily to be, you know, thinking about and referring patients to us.

YouTube Education Drives Growth

SPEAKER_01 53:10

Um, so I knew we were gonna have to educate people directly. That's a lot of work, that takes a lot of money. Um, you know, when you're breaking ice for the first time, and you're the one breaking the ice, you know, people behind you can just follow you, right? It makes it easier. They're not having to go up against the ice. We're going up against the ice. And so um what makes that easier is is is the educational process. So I knew that was really important in the beginning, um, which is why we developed uh we use so we use AI, and I know everybody's using that term these days, right? Um, but it's it's relevant in this case, so I'll I'll bring it up. Not only do we use AI on the diagnosis, on the medical side of the business, which is critical, and it's game-changing. It is really game-changing, and it's going to change the industry forever. Um, and we I could talk for hours about that, but we also use AI on the front end of the business, which is the funnel. And we develop these incredible machine learning tools, um, AI tools, um, and funnels. Uh, we use programs like Go High Level to develop all of this to allow for um automation um and to learn from itself to get better. Because the better we off we are at that, the more lives we can save. Um, and and in order to save lives, we've got to educate people, we've got to get to people, we've got to educate them, we've got to build trust, uh, authority in the market, and then enough, and then provide, make it easy for them to pick up the phone, right? Uh or get on the computer and set up. We've got to make it easy for them. And you know, we take that very seriously. It is our mission. You know, we say your heart is our mission, it is absolutely critical. So if we fail at that, we fail at our business, not just from a monetary perspective, right? That's that's the effect. The money comes when you do a good job of taking care of the patient, of educating the patient and taking care of the patient and and and showing them, proving to them that what we're doing is is improving their lives. Okay. Then the money will come because people will see the value. So I knew it from the beginning. Sherry's the one that really does all the education on that side of things. I just support her, but that was critical, knowing right up front that we needed to communicate directly to the to the to the potential patients um until we get to the point, and forever, but until we get to the point where we have enough traction where patients are actually advocating on our behalf, which is what's happening now through the affiliate program and so on.

Dr Andrew Greenland 55:41

So

Scaling Locations And Long Term Vision

Dr Andrew Greenland 55:42

turning to the future, where would you like to be in you know 12 months' time with clear cardio? Any plans on the horizon? Where are you looking to kind of um go with the business and the clinic?

SPEAKER_01 55:54

On a beach in Cabo with a hundred of my patients and my entire staff celebrating our our our you know, our 10,000th patient. Right? Because you've got to celebrate, you know, um, otherwise you just like hit your head against the wall because it's hard. This is a hard business to be in. You know, um, it's a hard business. Uh, you've got doctors you're dealing with, you've got you've got um malpractices insurance, you've got lawyers up the yin yang protection, and you've got you're dealing with people that are sick or worried well, um, and you you know, you know, they're trusting you, so you've got to be responsive. You've got call centers, you've got AI, you've got medications, and you're dealing with, I mean, there's so it's such a complex business. Um, that you've got to, you've got to, you know, celebrate the wins. So one year from now, I'd like to be celebrating, you know, um 10,000 patients have gone through the clear cardio program or are going through the clear cardio program. I'd like to be celebrating our next office opening. We have an office. Um, we have three offices now, one in Miami Beach, one in uh Manhattan on Park Avenue. Um, one our headquarters in Dallas and Carrollton. Uh, we're opening one up in Scottsdale by the end of September. Um, so we'll have four locations. My goal is and within 12 months to be uh in California, two locations in California, another location to be determined. So I'd like to have seven or eight locations by the end of next year. That'll allow us to be able to meet, you know, those see as many patients as we can. Um, because you have to dial you know your ad spend on the social media stuff. You got to dial it right so you don't sell yourself out of business. Because the minute you your quality of service drops, well then, you know, one bad review and and and trustpilot, like you know, we have five star, we have hundreds of patients and hundreds of of reviews on trust pilot, all five star. You have one one star, and it drops you down to like 4.8. I think we're at a 4.8 because earlier on, I think we one patient was having some issues, internal family issues, and took it out on us. It happens. Um, but you know, all of those things that matter. But in 12 months, I want to be in in additional locations so that we can cover more people, more patients, and support them. I want to be celebrating those new patients. Um, and uh, you know, obviously I would like I want I want um I would I I think I'm this I'm the large I'm the sole investor in the company, so I put a lot of put millions of dollars into this business to get it to where it is today. I'm gonna continue to put money into it um as we expand, right? And the money that we do make, we reinvest back into the business, uh, and ideally to get costs down as much as we can. But that's where I'd like to be in 12 months, celebrating somewhere with with patients and staff on on the advancement of pericardio in the United States.

Dr Andrew Greenland 59:02

Amazing. Finally, if we were having this conversation in 10 years from now, what would you hope had changed?

SPEAKER_01 59:10

Yes, so I'm we are gonna get there. So um it's I want preventive cardiology, I want prevention and awareness. It the number one killer of all human beings on the earth. I want it to be an everyday conversation about plaque. I the same way you talk about the colonoscopy and and making sure that people aren't contracting and dying from colon cancer. I want I or for breast cancer for that. I mean, there's so much advocation for breast cancer, and I I there should be, um, because it's it's it's a devastating disease and it affects a lot of women and men, by the way, men die about breast cancer too. Um however, it is a segment of cancer. Um and we we will we will in 10 years have that level of education, awareness, proactive approach towards the number one killer of all people on the planet today, right today. Um, and and I want to see that number decrease.

Dr Andrew Greenland 1:00:26

What a great point

Final Takeaway: React Less, Prevent More

Dr Andrew Greenland 1:00:28

to end on. What a fantastic mission. JD, it's been an enormous pleasure. Thank you so much. What I love about today's conversation is that although we've talked about technology and AI, the underlying message is really about changing healthcare from reacting to disease to preventing it altogether. So thank you very much for sharing not only the vision behind ClearCommodio, but also the realities of building and leading a healthcare company that's really challenging existing thinking. I think um listeners, clinicians, health and entrepreneurs are going to take a great deal away from this um session. So thank you very much for joining me. It's been absolutely fantastic.

SPEAKER_01 1:00:59

It is my pleasure. Thank you for having me on.